ACP: Regulate E-Cigarettes, Ban Flavorings

Citing increases in e-cigarette use by young people, ACP recommends tougher oversight.

Action Points

The American College of Physicians (ACP) recommends tougher federal regulation of e-cigarettes and endorses an FDA proposal to include them under products regulated by the Tobacco Control Act.

The ACP says there is limited evidence on the health effects of electronic nicotine delivery systems (ENDS) and on their effectiveness in smoking cessation.

The American College of Physicians (ACP) wants tougher federal regulation of e-cigarettes, including a ban on flavored tobacco products, to discourage use among young people.

"While the long-term public health consequences of ENDS [electronic nicotine delivery systems] are unknown, the College believes that efforts should be made to oversee these novel products," wrote Ryan J. Crowley, BSJ, senior health policy analyst, and colleagues on the American College of Physicians' Health Public Policy Committee in Washington, D.C.

"The FDA's proposed regulation would provide the necessary oversight to ensure that ENDS manufacturers adhere to quality control guidelines and disclose accurate product information, including nicotine content," the authors wrote.

In a separate interview with MedPage Today, Crowley said these recommendations were not meant to provide clinical guidance, as there is limited evidence on the health effects of ENDS or their aid as a smoking cessation technique.

"The College strongly believes that efforts should be made to regulate these products to protect the health of ENDS users and nonusers," he said. "Given the recent findings that ENDS use has tripled among young people, the College supports policies to prohibit ENDS access and use among young people."

The ACP recommended a ban on all flavored tobacco products, including ENDS. With such flavors as chocolate, cotton candy, and Georgia peach available, the authors called the products "candy-flavored tobacco." They referenced a recent survey of ENDS users ages 18 to 24 who "exclusively" used flavored e-cigarettes compared with 65% of survey respondents over 25.

Further research was recommended for forming potential clinical guidelines for ENDS, overseen by an appropriate agency such as the Agency for Healthcare Research and Quality, the National Institutes of Health, or the Centers for Disease Control.

Other recommendations addressed in the paper included a higher local tax rate for ENDS similar to that of other tobacco products to discourage use by young people, restrictions on promotional and marketing displays for ENDS, and extending smoking bans to include the use of ENDS products in public places.

"ACP reaffirms its position that ENDS be regulated by the federal government and offers new recommendations calling for a ban on flavorings, restrictions on marketing and advertising, prohibitions on indoor use, and that research be conducted to better understand the health effects of ENDS use and exposure," Crowley concluded.

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